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Organo Oficial de la Sociedad Mexicana de Urología

2008, Number 2

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Rev Mex Urol 2008; 68 (2)

Microscopic Focus Diagnosis of Prostate Adenocarcinoma; Morphological and Immunohistochemical study of 143 cases

Martínez-Arroyo C, Buys DLJ, Salgueiro-Ergueta R, Paredes-Mendoza J, Marina-González JM, Zonana-Farca E, Zarate-Osorno A

Language: Spanish
References: 25
Page: 103-110
PDF size: 157.98 Kb.


ABSTRACT

Introduction: Prostate-specific antigen (PSA) elevation, together with digital rectal examination clinical data and transrectal ultrasound findings, can be highly suggestive of prostate cancer. Its precise diagnosis, however, is established by transrectal prostate biopsy analysis. From a morphological viewpoint, some histological changes can be suggestive of prostate cancer, but none of these changes are, in themselves, diagnostic. Under these circumstances, atypical small acinar proliferation (ASAP) is often diagnosed.
Objective: To analyze a series of cases of ASAP microscopic foci, some of them suggestive of adenocarcinoma, others of high-grade intraepithelial neoplasm (IEN) and others simply of ASAP.
Materials and Methods: One hundred and forty-three prostate biopsies analyzed by IHC were collected. The 143 biopsies corresponded to 133 patients, 10 of whom had had two biopsies taken simultaneously. Of the 143 biopsies, 127 were studied with the three markers.
Results: After IHC re-evaluation, the definitive diagnoses were: 68 (47.5%) adenocarcinoma, 51 (35.7%) benign proliferation, 14 (9.8%) high-grade IEN and 10 (7%) ASAP.
Once the 70 morphological biopsies suggestive of adenocarcinoma were evaluated by IHC, malignancy was confirmed in 58 cases (82.8%) by negativity to the basal cell markers in all 58 cases and by periluminal granular positivity with P504S in 50 of the 58 cases.
Conclusion: When a microscopic focus is suggestive of adenocarcinoma, ASAP or high-grade IEN, IHC study with 34betaE12 cytokeratin and p63 protein, for basal cells, and P504S racemase, for neoplastic cells, is highly recommended in order to establish an unequivocal adenocarcinoma diagnosis.


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